Initial airway function is a risk factor for recurrent wheezing respiratory illnesses during the first three years of life

We recently reported a significant relationship between lung function measured prior to any lower respiratory tract illness and subsequent wheezing illnesses during the first year of life (N Engl J Med 1988; 319:1112-7). Follow-up has continued for this group of infants during the second and third years of life. When compared with never wheezers, infants who wheezed during the first year of life and had at least one additional lower respiratory illness had 22% lower initial levels of an indirect index of airway conductance derived from the shape of tidal breathing curves (p ≤ 0.01), 22% lower respiratory conductance (p ≤ 0.05), 25% lower maximal flows at the end-expiratory point (p ≤ 0.01), and 10% lower functional residual capacity (p ≤ 0.05). Infants who wheezed only once during the first 3 yr of life or who started wheezing during the second year of life had normal tidal breathing curves but significantly lower maximal expiratory flows (p ≤ 0.05). Their functional residual capacity was also lower than that of never wheezers (p ≤ 0.05). We conclude that diminished initial airway function may be a predisposing factor for recurrent wheezing respiratory illnesses starting in the first year of life. Infants who will have only one wheezing respiratory illness or who will start wheezing after the first year of life seem to have lower levels for some but not for all lung function tests performed in this study.